Surrender Your Pet Application Form

About you

Your first name

Your last name

Your address

Please include suburb and postcode

Your phone

Your email

Your date of birth

Your drivers licence number (please include state, if not WA)

Why do you need to surrender your pet?

About your pet

Type of pet

Your pet's name

Your pet's breed

Your pet's age

Your pet's weight

Gender

Female

Male

Is your pet microchipped?

Yes

No

Not sure

If Yes, your pet's microchip number

Which council is your cat registered with?

Is your pet microchipped?

Yes

No

Not sure

Date of last vaccination

Date of last flea treatment

Date of last worming treatment

Who is currently caring for this pet?

Where did you get this pet from?

How long have you owned this pet?

About Your Pet’s Health

Name of your vet’s practice

Your vet’s phone number

Please indicate your consent for RSPCA WA to contact your vet and request medical records for this pet.

I consent for RSPCA WA to contact my vet to access this pet’s medical records.

Does your cat have any existing medical conditions?

Yes

No

If Yes, please provide details

Is your cat currently receiving any medical treatment or medications?

Yes

No

If Yes, please provide details (e.g. name/type of medication, dosage, etc.)

What type of food does your cat eat? (Please include brand names, quantities, and frequency of feeds)

While your application is being assessed, please obtain a copy of your pet’s medical history from your vet, or ask them to email it to us at surrenders@rspcawa.org.au.

About Your Pet’s Environment

Please describe the type of home where this pet is kept.

If Other, please specify

Are there children in your household?

Yes

No

If Yes, please provide details (e.g. number of children, ages, etc.)

On a daily basis, how much time does your cat spend indoors?

On a daily basis, how much time does your cat spend outdoors?

Does your pet use a litter tray?

Yes

No

On average, how many hours per day is your cat left alone?

Where does your pet spend most of its time when left alone?

Where does your pet sleep at night?

About Your Pet’s Behaviour

Is your pet around other animals?

Yes

No

If Yes, please describe what kind of animals and how they interact.

What things does your pet like or enjoy? (e.g. chin scratches, sitting up high, etc.)

What things does your pet dislike? (e.g. belly rubs, being picked up, etc.)

Is your pet scared of anything? (e.g. loud noises, fireworks, thunder, etc.)

Are there any other behaviour concerns you think we should know about?

Please tell us anything else you think we should know about your pet.

Declaration

Please choose ONE from the following:

As the sole legal and beneficial owner of the animal described above, I declare that: 1) I surrender as the sole legal and beneficial owner, the animal free of any third party; 2) I surrender all my rights, titles and interest in the animal to RSPCA WA and in doing so I understand that the animal will become the sole and absolute property of RSPCA WA; 3) I agree to indemnify RSPCA WA and keep RSPCA WA so indemnified against all claims (if any), costs and expenses whatsoever arising out of any action by any person claiming an interest in the animal; 4) I am 18 years of age or older.

The animal is not owned by me, I am not aware of the animal’s true owner and I have made all reasonable efforts to identify the owner, therefore I believe the animal to be a stray.

The animal has been abandoned by a third party at a property owned or controlled by me.

Next Steps

Once you submit this form, it will be sent to the Shelter team. Once they assess your application, they will contact you on the number you have provided above to discuss your application in further detail. This should take around 3 business days.

In the meantime, please contact your vet and request a medical history of your pet. They can either send it to you, or they can send it directly to surrender@rspcawa.org.au.

Again, thank you for reaching out for help with your pet.